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�'��� _ . <br />��..v_� , �__�._� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7034 <br />Massage Therapy Establishment License Application <br />�� <br />Business Name �� �T- �- �� �_�� �� � �� . _ . � 4 •`� � .� � �rc'. � - <br />Business Address � �_ � : � __ . � � _ � � � <br />Business Phone �l � � � �' l � � � � 1 �_ <br />— � - � <br />�.tnail Address <br />f�'t'rti r,r. �r� f'r�nr�� r��r �i�h�rirr± itir �i�.7 ir�� ti s�i� t�ir,s� � <br />i <br />I �u�l TJame 1 �''� , ��`��+��- �. k'�•ti l� C .. �� _ ,-. <br />- � .-•— - - ��. <br />f5��it•�y _ �= - � ` � 1 =-r ._. . � � � <br />Phone u- _ Date of Birth <br />Drivers License Number � <br />1 hereby apply for the following Iicense(sj for the term of one year, beginning July 1, ��� �� , and ending June <br />31, � C> a , in the City of Roseville, County of Ramsey, State of Minnesota. <br />License Required F�e <br />Massage Therapy Establishment $300.00 <br />$150.00Bacicground Checic <br />(new license only) <br />The undersigned applicant malces ihis application pursuant t�: ,i I! IFi� J��r 5 0: LIIY � 7�: �}� �'I inne�� i�� ari� r��u„�114i7 05 <br />the Council of the City of Roseville may from time to time �rt �t ri I�, � n:tl �1 �� r'�°�int'�;n iti� � 17�k I�. <br />. . �- _ . ��.._..... <br />Si nature � � . ! -��-�' "� <br />g . H ���,- ��.• ���. -- _ <br />I ].�I.: C� �+ r { �� � '� ,.�� _ — <br />lf completed license should be mailed somewhere other than the business address, please advise. <br />